tbuckley/cabot-search huggingface dataset:
Abstract 176: Development Of A Novel Score To Predict Brain Death After Out Of Hospital Cardiac Arrest
Authors: Eva Kitlen, Noah Kim, Alexandra Rubenstein, Caitlyn Keenan, David M Greer, emily j gilmore, Rachel Beekman
Journal: Circulation (2022)

Introduction: Brain death occurs in 10-15% of successfully resuscitated out-of-hospital cardiac arrest (OHCA) patients. Early identification of potential organ donors is critical to prevent withdrawal of life sustaining therapy (WLST) and ensure adequate organ perfusion. To predict brain death after OHCA, we developed a novel brain death risk (BDR) score. Methods: The BDR score was developed from a retrospective, single center cohort of OHCA patients admitted from 2011-2020. After excluding patients with early WLST (defined as &lt; 72 hours from OHCA), univariate regression models identified independent predictors of brain death, which were used to build the BDR score. We included the following variables: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1-5 (1 point), and age &lt; 45 years (1 point). Head CT findings were based on neuroradiology reports. We validated the BDR score in an independent single center OHCA cohort. The primary outcome was occurrence of brain death. Using the area under the receiving operator characteristic curve (AUC), we assessed the score’s prediction of brain death. Results: The development cohort included 256 OHCA patients; 15.6% (40/256) experienced brain death. The AUC (95% CI) of the BDR score was 0.921 (0.870-0.971). In the validation cohort, 24.4% (21/86) experienced brain death. The AUC (95% CI) of the BDR score was 0.830 (0.7266-0.9335). Table 1 shows the rate of brain death at each BDR score. In both cohorts, a BDR score ≥ 5 was the optimal cut off (sensitivity 0.9 and 0.714, specificity 0.843 and 0.831, respectively). Conclusion: Early scoring systems may be able to identify those at highest risk for brain death after OHCA. Our data suggest that a BDR score ≥ 5 could help predict progression to brain death.
Abstract 157: Diagnostic Test Accuracy Of The ST-segment Elevation Myocardial Infarction Equivalents In Electrocardiogram After Return Of Spontaneous Circulation Among Out-of-hospital Cardiac Arrest Patients Without ST-segment Elevation
Authors: Satoshi Yoshimura, Takeyuki Kiguchi, Taro Irisawa, Changhwi Park, Tomoki Yamada, Tetsuro Nishimura, TAKU SOGABE, Atsunori Onoe, Ito Yusuke, Takaya Morooka, Tetsuhisa Kitamura, Taku Iwami
Journal: Circulation (2022)

Background: Out-of-hospital cardiac arrest (OHCA) patients with acute coronary syndrome (ACS) needs emergent coronary angiography and subsequent percutaneous coronary intervention to improve their outcomes. ‘STEMI equivalents’ in electrocardiogram (ECG) are known to help the diagnosis of ACS. However, these findings have not been sufficiently evaluated among OHCA patients. This study aimed to evaluate the diagnostic test accuracy (DTA) of ‘STEMI equivalents’ to identify ACS among OHCA patients without ST-segment elevation. Methods/Results: Nine emergency medical departments among the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival (CRITICAL) study in Osaka, Japan collected the patients' first 12 leads ECGs after return of spontaneous circulation (ROSC) from 2012 to 2017. Patients with non-traumatic OHCA aged &gt;=18 years old with ventricular fibrillation / pulseless ventricular tachycardia as first documented rhythm or rhythm at hospital arrival were included. Of them, patients without ST-segment elevation nor complete left bundle branch block were extracted. The DTAs; sensitivity, specificity, positive likelihood ratio (LR+), and negative and likelihood ratio (LR-) of STEMI equivalents (i.e., Isolated T-wave inversion, Wellens signs) for the diagnosis of the ACS were evaluated. ACS was diagnosed by the physicians in each hospital based on the coronary angiography. Results: A total of 143 cases were included in the analysis and 79 patients were diagnosed as ACS. Isolated T-wave inversion was found in 7 (3.2%) patients in the ACS group and 3 (8.8%) in the non-ACS group. The Wellens signs was present in 5 (6.3%) and 5 (7.8%) patients, respectively. The isolated T-wave inversion and the Wellens signs had high specificity with 0.95 (95% CI: 0.87-0.99) and 0.92 (95% CI: 0.82-0.97), whereas these findings had low LR+ with wide range of 95% CI with 1.89 (95% CI: 0.51-7.02), and 0.81 (95% CI: 0.25-2.68), respectively. Conclusion: In this study, the DTA of STEMI equivalents of single 12 leads ECG alone were not sufficient for the diagnosis of ACS after ROSC among OHCA patients without ST-segment elevation. Further investigation of the DTA evaluation considering the measurement timing and the change of the ECG is needed.
Abstract 15459: High Intensity Interval Training versus Moderate Continuous Training in Patients With Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Tariq J Siddiqi, Muhammad Shariq S Usman, Ahmed Mustafa Rashid, Ahmed K Siddiqi, Daisuke Kamimura, Ambarish Pandey, Carl J LAVIE, Robert J Mentz, Javed Butler, Michael E Hall
Journal: Circulation (2022)

Introduction: Heart failure with preserved ejection fraction (HFpEF) is a common condition with one of its characteristics being exercise intolerance, which contributes to poor quality of life and clinical outcomes. High-intensity interval training (HIIT) is an innovative training approach, but its impact on patients with HFpEF is uncertain. We pooled data from all relevant studies reporting results of HIIT versus moderate continuous training (MCT) on cardiopulmonary exercise outcomes in patients with HFpEF. Methods: PubMed and SCOPUS were queried until February, 2022 for all randomized controlled trials (RCT) comparing the effects of HIIT versus MCT on outcomes such as peak oxygen consumption (peak VO 2 ), respiratory exchange ratio (RER), and minute ventilation / carbon dioxide production (VE/CO 2 )&gt; slope. A random-effects model was used and weighted mean differences (WMDs) were reported with 95% confidence intervals (CI). Heterogeneity across studies was evaluated using the Higgins I 2 statistic. Results: Three RCTs (n = 150) were included in our analysis. The mean training duration was 23 weeks (range: 4 - 52 weeks). Pooled analysis demonstrated that HIIT significantly improved peak VO 2 (WMD = 1.46 mL.kg -1 .min -1 (0.88, 2.05); p &lt;0.00001; I 2 =0%; Figure 1a), as compared to MCT in patients with HFpEF. However, no significant differences were demonstrated between HIIT and MCT, for RER (WMD = -0.10 (-0.32, 0.12); p =0.38; I 2 =0%; Figure 1b), and VE/CO 2 slope (WMD = 0.62 (-1.99, 3.24); p =0.64; I 2 =67%; Figure 1c). Conclusions: Our study demonstrates that HIIT, compared to MCT, had a significant impact on improving peak VO 2 , without evidence of significant benefits on VE/CO 2 slope. Larger trials of exercise training in HFpEF may consider peak VO 2 as a key outcome measure in addition to clinical events. Nevertheless, these improvements in peak VO 2 with HIIT could translate into improvements in quality of life and clinical outcomes in patients with HFpEF.
Abstract 15407: Benefits of the Sglt2 Inhibitor Empagliflozin on Epicardial Adipose Tissue in Non-Diabetic Hfref
Authors: Carlos G Santosgallego, Juan Antonio Requena-Ibanez, Maria Belen Picatoste Botija, Kiyotake Ishikawa, Javier Sanz, Valentin Fuster, Juan J Badimon
Journal: Circulation (2022)

Introduction: SGLT2 inhibitors cause weight loss, and reduce epicardial adipose tissue (EAT) on T2DM. The effects of T2DM on non-diabetic HFrEF remain unclear. Methods: HFrEF was induced in non-diabetic pigs via percutaneous oclusion of LAD (LVEF 30±4%). Animals were randomized to empagliflozin 10mg daily or placebo (n=8/group) for 2 months, and animals were subsequently euthanized. Cardiac MRI and echocardiography were performed before and after treatment. Invasive hemodynamics, histology and molecular biology were performed at 2-months. Primary culture of adipocytes from EAT was performed. Results: Empagliflozin caused reverse LV remodeling, reduced LVEDV and improved LVEF (Table). EAT volume was inversely associated with myocardial consumption of free fatty acids (r=-0.6, p=&lt;0.05). Empagliflozin reduced EAT, both as MRI-determined EAT volume and histologically-evaluated adipocyte size (Table). Empagliflozin induced lipolysis in the adipocytes from EAT, as demonstrated by lower levels of triglycerides and perilipin (main protein responsible for triglyceride storage), and higher levels of the lipolytic enzymes lipoprotein lipase and hormone-sensitive lipase. Empagliflozin caused an anti-inflammatory effect on EAT as shown by lower levels of macrophage infiltration and MCP-1. Empagliflozin exerted antioxidant actions, as per reduced levels of 8-OH-deoxyguanosine and malonildealdehide (oxidative stress markers in nuclei and protein, respectively. Conclusions: Empagliflozin exerts multiple benefits on EAT in non-diabetic HFrEF. Empagliflozin induces a lipolytic state that reduces EAT volume, and it also ameliorates the oxidative and inflammatory status of EAT.
Abstract 15449: Gaps In Diverse Racial/Ethnic Representation in High Impact Studies of Lipoprotein (a) and Atherosclerotic Cardiovascular Disease
Authors: Sumeet S Brar, Fatima Rodriguez, Ashish Sarraju
Journal: Circulation (2022)

Introduction: Lipoprotein (a) [Lp(a)] is an emerging target for atherosclerotic cardiovascular disease (ASCVD) with racial/ethnic differences that may link with ASCVD. Compared to non-Hispanic White (NHW) individuals, Asian and Black individuals have high Lp(a) levels. We evaluated diverse racial/ethnic reporting and representation in high impact studies of Lp(a) and ASCVD that inform major Lp(a) scientific statements. Methods: We reviewed the 2022 American Heart Association (AHA) Scientific Statement on Lipoprotein (a) and the 2019 Scientific Statement from the National Lipid Association (NLA) on the Use of Lipoprotein (a) in Clinical Practice for all cited observational studies or trials of Lp(a) and ASCVD. For studies of the same cohort, only the one with the largest sample size was included. Meta-analyses were excluded to avoid duplication. Manuscripts and supplements were systematically reviewed for participant race/ethnicity data. Participation (%) was pooled across studies for overall representation. In a sub-analysis of US studies, pooled representation was compared with 2020 US Census data. Results: A total of 58 studies met inclusion criteria. Only 33 (57%) reported any race/ethnicity. Reporting studies (participant n=701859) had 92% NHW, 2.6% Black, 0.6% Hispanic, 3.2% Asian, and &lt;0.1% American Indian/Alaskan Native or Native Hawaiian/Pacific Islander participants. No Lp(a) studies disaggregated Hispanic subgroups and 5 disaggregated Asian subgroups. In US studies, Hispanic and Asian representation was lower than 2020 US Census data (Fig). Conclusions: High impact studies of Lp(a) and ASCVD underreport and rarely disaggregate participant race/ethnicity and have low overall Black, Hispanic, and Asian representation. Among US studies, Hispanic and Asian groups are underrepresented versus 2020 Census data. Efforts are needed to improve diverse study race/ethnicity reporting and representation for this emerging therapeutic target.
Abstract 173: Update And External Validation Of A Prognostic Model To Predict Neurological Outcomes At 90 Days In Out-of-hospital Patients With Cardiac Arrest
Authors: NORIHIRO NISHIOKA, Takeyuki Kiguchi, Tetsuhisa Kitamura, Taku Iwami
Journal: Circulation (2022)

Introduction: An accurate assessment of postcardiac syndrome (PCAS) is crucial for achieving good neurological outcomes. Herein, we modified and refitted the existing prognostic model in the updated derivation set and externally validated it. Methods: Data used to update the model included those from adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients with return of spontaneous circulation (ROSC) between Jan. 2013 and Dec. 2019 from the CRITICAL study (a multicenter registry in Osaka, Japan). The outcome was the dichotomized 90-day Cerebral Performance Category. The model was updated by logistic regression with the least absolute shrinkage and selection operator regularization. External validation included OHCA patients with ROSC, between Jan. 2013 and Dec. 2019, from the JAAM-OHCA registry (a nationwide multicenter registry in Japan), which geographically differs from the derivation set. The model performance was assessed in the validation set. Results: We updated the model in the derivation set (n = 3391). In the validation set (n = 6185), compared to Model A’s (variables with prehospital or pre-ROSC) C-statistics of 0.941 (95% CI: 0.933-0.950), Model B’s (Model A + first in-hospital documented cardiac rhythm) and Model C’s (Model B + laboratory data available immediately post-ROSC) C-statistics increased to 0.948 (0.940-0.956) and 0.959 (0.953-0.965), respectively (Fig. 1). All models were well-calibrated to the observed outcome. Model C produced higher net benefits at all risk thresholds following decision curve analysis (Fig. 2). A web-based calculator can show the probability of a poor outcome (https://pcas-prediction.shinyapps.io/90d_lasso/). Conclusion: In the validation set, the updated model showed excellent performance in predicting neurological outcomes at 90 days in patients with postcardiac syndrome. Additional laboratory data can provide better prediction by removing ambiguous predictors from the model.
Abstract 15689: Efficacy and Safety of Non-Fluoroscopic Radiofrequency Ablation of Ventricular Arrhythmias Originating in the Sinuses of Valsalva
Authors: Jorge Romero, Juan C Diaz, Luis Cerna, Isabella Alviz, Dimitrios Varrias, Suraj Krishnan, Daniel Rodriguez, Mohamed Gabr, Joan Rodriguez-Taveras, Jose Matias, Maria Gamero, KARTIKEYA P DAVE, Sutopa Purkayastha, Jorge Marin, Mauricio Duque, Dhanunjaya Lakkireddy, Andrea Natale, Domenico G Della Rocca, Luigi Di Biase
Journal: Circulation (2022)

Introduction: Catheter ablation (CA) for premature ventricular contractions (PVCs) coming from the sinus of Valsalva have been historically challenging due to complex anatomy and mobility of the valve cusps. More importantly, coronary angiography or aortogram was the standard or care during these procedures. Alternative imaging methods without the use of fluoroscopy have emerged as a new modality of radiofrequency ablation therapy. We sought to compare the safety and efficacy of fluoroscopy-based ablation vs. non-fluoroscopic ablation in patients who underwent CA of PVCs originating from the Sinuses of Valsalva. Methods: A retrospective analysis of 35 patients at Montefiore Medical Center who underwent CA of PVCs originating from the sinus of Valsalva was made. Considering “Use of fluoroscopy or not” as the primary grouping variable, multivariate linear and logistic regression models were created using STATA (version IC/16.1). The primary safety endpoint was absence of any procedure related complication; the primary efficacy endpoint was acute procedural success. The secondary endpoint was total procedural time. Results: Thirty-five patients underwent CA of PVCs from the right or left coronary cusps with a retrograde approach. The mean age was 62±13.6 years, with 48% being female. Eighteen (51.4 %) patients underwent a non-fluoroscopic approach. There were no differences in the primary safety and efficacy endpoints. There were no complications and all cases were successful. The mean procedural time in the non-fluoroscopic group was 138 minutes (SD=34.8) compared to 227 (SD=71) in the fluoroscopic approach (p= 0.001). When controlled for baseline characteristics in a linear regression model, fluoroscopy was the only independent association with procedural time, increasing it by 98 minutes (SE =20.4, p =0.001). Conclusion: Non-fluoroscopic CA is a feasible technique for PVCs originating from complex locations including the Sinuses of Valsalva, demonstrating similar safety and efficacy. Moreover, a fluoroless approach is associated with decreased procedural times and eliminates the risks associated with radiation exposure, thus improving lab efficiency and reducing the risks of lead associated orthopedic injuries.
Abstract 227: Acute Inpatient Rehabilitation And Social Determinants Of Health Are Associated With Functional Recovery Patterns At 12 Months Relative To Hospital Discharge From Cardiac Arrest.
Authors: Sachin Agarwal, Edmund Q Shen, Isabella M Tincher, Sabine L Abukhadra, David Roh, Soojin Park, Jan Claassen, Donald E Edmondson, Jacquelyn Y Taylor, Amy K Wagner, Clifton W Callaway
Journal: Circulation (2022)

Introduction: Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions. Methods: Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics. Results: Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p&lt;0.01). In a multivariable model, acute inpatient rehabilitation was significantly associated with a good recovery pattern when compared to other discharge dispositions (home with out-patient rehabilitation services (odds ratio (OR), 0.3; CI, 0.1-0.8; p = 0.02), and skilled nursing facility (OR, 0.2; CI, 0.1-0.6; p&lt;0.01). SDOH including minority race/ethnicity, poor insurance, premorbid unemployment, no carepartner or spouse, and patients with longer hospital length of stay had independent and significant associations with poor functional recovery patterns. Conclusions: Acute inpatient rehabilitation was associated with a good functional recovery pattern 12 months after hospital discharge from CA. Social determinants of health have an independent effect on the functional recovery patterns and should be systematically collected for future outcome-based studies.
Abstract 14545: Extramedullary Plasmacytoma of Tonsil Presenting as Cardiac Amyloidosis
Authors: Rahat Ahmed A Memon, Donald Haas, Chaitra Janga, Hamza Muhammadzai, Shravya Ginnaram, Lucy Checchio
Journal: Circulation (2022)

Introduction: AL amyloidosis is a systemic disease characterized by the deposition of misfolded immunoglobulin light chains produced from clonal plasma cells in multiple organs of the body causing its dysfunction. We present you an unusual case of AL cardiac amyloidosis in a patient with extramedullary plasmacytoma of the tonsils. Case Presentation 61-year-old female presented with dyspnea on exertion with NT-proBNP elevated to 1439 pg/ml. CXR showed increased pulmonary vascular congestion. The patient was started on IV furosemide 40 mg BID with good urine output. Transthoracic echocardiogram revealed left ventricular hypertrophy with an ejection fraction of 60-65% with a global longitudinal strain of -9.0% and regional longitudinal strain reduced in the basal and mid-left ventricular segment but preserved in apical segment consistent with infiltrative cardiomyopathy. The patient underwent a nuclear (nuclear technetium pyrophosphate) scan of the heart consistent with cardiac amyloid deposition. She also was noted to have increased tonsillar mass which was biopsied. In the hospital, the patient had a cardiac arrest with the initial rhythm being ventricular fibrillation. The patient received 6 rounds of shock, and multiple injections of epinephrine, amiodarone, and bicarbonate push. The patient died despite all efforts of resuscitation. Histopathology results of tonsillar mass were consistent with plasmacytoma with amyloid deposition on Congo-red stain. Lambda: Kappa ratio was 70:1. Discussion: In cardiac amyloidosis, light chain deposits between cardiac myocytes disrupt cell-cell interaction. It can present as restrictive cardiomyopathy, conduction system abnormalities, or sudden cardiac death. It is essential to diagnose cardiac amyloidosis earlier. If untreated, the median survival of patients with cardiac AL amyloidosis is 6 months from the onset of heart failure. Conclusion: Our case was unusual in which a rare tumor of tonsils had plasma cell tumor which led to cardiac amyloidosis
Abstract 15731: <i>Rpl13a</i> Small Nucleolar RNAs Promote Atherosclerosis and Oxidative Stress
Authors: Lisheng Zhang, Jiao-Hui Wu, Brittany A Elliott, xinhe yin, Kamie P Snow, Neil J FREEDMAN, Christopher L Holley
Journal: Circulation (2022)

Reactive oxygen species (ROS) exacerbate atherosclerosis (athero). ROS levels are elevated by specific non-coding, small nucleolar (sno) RNAs encoded within introns of the Rpl13a gene. We therefore tested the hypothesis that these snoRNAs promote athero, using “snoKO” mice deficient in Rpl13a snoRNAs, but not in Rpl13a itself. ROS levels assessed by CellROX Orange were 35% lower in snoKO than snoRNA +/+ aorta frozen sections ( p &lt;0.01). After 14 wk on Western diet, female snoKO/ Apoe -/- unexpectedly showed total cholesterol levels 20% higher than Apoe -/- mice in (1,046 vs 869 mg/dl, p &lt;0.05). Despite this, neointimal lesions in brachiocephalic artery (BCA) cross-sections were 50% smaller in snoKO/ Apoe -/- than in Apoe -/- mice, and lumen size was 45% larger (both p &lt;0.01, n=8/group). Similar data were obtained in males: snoKO/ Apoe -/- mice had 40% smaller BCA lesion areas ( p &lt;0.02, n=8/group). After being stained for cholesteryl ester with BODIPY, for ACTA2 by immunofluorescence and for DNA (Hoechst), BCAs from female snoKO/ Apoe -/- mice (n=9) demonstrated 50% less foam cell-positive and 95% more ACTA2 + area, 40% less necrotic core area, and a 60% lower prevalence of ACTA2 + foam cells ( p &lt;0.05 for each). Thus, Rpl13a snoRNAs promote vascular ROS and athero. Assessed by MitoSOX Red, ROS levels were 25% lower in snoKO than WT M1-polarized bone marrow-derived Mϕs in vitro (n=3, p&lt;0.05). To identify mechanisms linking the Rpl13a snoRNAs to ROS and athero, we performed LC-MS/MS on WT and snoKO aortic SMCs. COX4I2 was expressed 5.7-fold higher in snoKO than WT SMCs by MS/MS, and 2.5-fold higher in snoKO SMCs by immunoblot (n=3/group, p &lt;0.05). As part of mitochondrial complex IV, COX4I2 lowers cellular ROS levels. We used CRISPR/Cas9 to create 293T cells lacking either the RPL13a -snoRNA U34A or the irrelevant snoRNA U25 . With mRNA from these cells we performed reverse transcription at low [dNTP] followed by qPCR (RTL-P) for COX4I2 . Inversely proportional to the degree of mRNA 2’- O -methylation (mediated by snoRNAs), the RTL-P efficiency was 4-fold higher in U34A -knockout than control cells (3 clones/genotype, p &lt;0.01). Thus, COX4I2 mRNA appears to be regulated by RPL13A -snoRNA-guided 2’- O -methylation in a manner that could link Rpl13a snoRNAs, vascular ROS, and athero.